Basic Information
| Provider Information | |||||||||
| NPI: | 1972690915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATOLOT | ||||||||
| FirstName: | ARIUS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 BEISNER RD STE 1500 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476315664 | ||||||||
| FaxNumber: | 8476315663 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 BEISNER RD STE 1500 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476315664 | ||||||||
| FaxNumber: | 8476315663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 036-100141 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 158372300 | 01 | IL | DEPT OF LABOR | OTHER | 036100141-2 | 05 | IL | MEDICAID | 4521533 | 01 | IL | BCBS | OTHER |